APC Status Codes and Titles Effective 10-01-2000 Source: HCFA OCE/APC Module, September 2000 00001 S PHOTOCHEMOTHERAPY 00002 T FINE NEEDLE BIOPSY/ASPIRATION 00003 T BONE MARROW BIOPSY/ASPIRATION 00004 T LEVEL I NEEDLE BIOPSY/ ASPIRATION EXCEPT BONE MARROW 00005 T LEVEL II NEEDLE BIOPSY /ASPIRATION EXCEPT BONE MARROW 00006 T LEVEL I INCISION & DRAINAGE 00007 T LEVEL II INCISION & DRAINAGE 00008 T LEVEL III INCISION & DRAINAGE 00009 T NAIL PROCEDURES 00010 T LEVEL I DESTRUCTION OF LESION 00011 T LEVEL II DESTRUCTION OF LESION 00012 T LEVEL I DEBRIDEMENT & DESTRUCTION 00013 T LEVEL II DEBRIDEMENT & DESTRUCTION 00014 T LEVEL III DEBRIDEMENT & DESTRUCTION 00015 T LEVEL IV DEBRIDEMENT & DESTRUCTION 00016 T LEVEL V DEBRIDEMENT & DESTRUCTION 00017 T LEVEL VI DEBRIDEMENT & DESTRUCTION 00018 T BIOPSY SKIN, SUBCUTANEOUS TISSUE OR MUCOUS MEMBRANE 00019 T LEVEL I EXCISION/ BIOPSY 00020 T LEVEL II EXCISION/ BIOPSY 00021 T LEVEL III EXCISION/ BIOPSY 00022 T LEVEL IV EXCISION/ BIOPSY 00023 T EXPLORATION PENETRATING WOUND 00024 T LEVEL I SKIN REPAIR 00025 T LEVEL II SKIN REPAIR 00026 T LEVEL III SKIN REPAIR 00027 T LEVEL IV SKIN REPAIR 00029 T INCISION/EXCISION BREAST 00030 T BREAST RECONSTRUCTION/MASTECTOMY 00031 S HYPERBARIC OXYGEN 00032 T PLACEMENT TRANSVENOUS CATHETERS/ARTERIAL CUTDOWN 00033 P PARTIAL HOSPITALIZATION 00034 P DAILY MENTAL HEALTH SERVICES 00040 T ARTHROCENTESIS & LIGAMENT/TENDON INJECTION 00041 T ARTHROSCOPY 00042 T ARTHROSCOPICALLY-AIDED PROCEDURES 00043 T CLOSED TREATMENT FRACTURE FINGER/TOE/TRUNK 00044 T CLOSED TREATMENT FRACTURE/DISLOCATION EXCEPT FINGER/TOE/TRUNK 00045 T BONE/JOINT MANIPULATION UNDER ANESTHESIA 00046 T OPEN/PERCUTANEOUS TREATMENT FRACTURE OR DISLOCATION 00047 T ARTHROPLASTY WITHOUT PROSTHESIS 00048 T ARTHROPLASTY WITH PROSTHESIS 00049 T LEVEL I MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT 00050 T LEVEL II MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT 00051 T LEVEL III MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT 00052 T LEVEL IV MUSCULOSKELETAL PROCEDURES EXCEPT HAND AND FOOT 00053 T LEVEL I HAND MUSCULOSKELETAL PROCEDURES 00054 T LEVEL II HAND MUSCULOSKELETAL PROCEDURES 00055 T LEVEL I FOOT MUSCULOSKELETAL PROCEDURES 00056 T LEVEL II FOOT MUSCULOSKELETAL PROCEDURES 00057 T BUNION PROCEDURES 00058 S LEVEL I STRAPPING AND CAST APPLICATION 00059 S LEVEL II STRAPPING AND CAST APPLICATION 00060 S MANIPULATION THERAPY 00070 T THORACENTESIS/LAVAGE PROCEDURES 00071 T LEVEL I ENDOSCOPY UPPER AIRWAY 00072 T LEVEL II ENDOSCOPY UPPER AIRWAY 00073 T LEVEL III ENDOSCOPY UPPER AIRWAY 00074 T LEVEL IV ENDOSCOPY UPPER AIRWAY 00075 T LEVEL V ENDOSCOPY UPPER AIRWAY 00076 T ENDOSCOPY LOWER AIRWAY 00077 S LEVEL I PULMONARY TREATMENT 00078 S LEVEL II PULMONARY TREATMENT 00079 S VENTILATION INITIATION AND MANAGEMENT 00080 T DIAGNOSTIC CARDIAC CATHETERIZATION 00081 T NON-CORONARY ANGIOPLASTY OR ATHERECTOMY 00082 T CORONARY ATHERECTOMY 00083 T CORONARY ANGIOSPLASTY 00084 S LEVEL I ELECTROPHYSIOLOGIC EVALUATION 00085 S LEVEL II ELECTROPHYSIOLOGIC EVALUATION 00086 S ABLATE HEART DYSRHYTHM FOCUS 00087 S CARDIAC ELECTROPHYSIOLOGIC RECORDING/MAPPING 00088 T THROMBECTOMY 00089 T LEVEL I IMPLANTATION/REMOVAL/REVISION OF PACEMAKER, AICD OR VASCULAR DEVICE 00090 T LEVEL II IMPLANTATION/REMOVAL/REVISION OF PACEMAKER, AICD OR VASCULAR DEVICE 00091 T LEVEL I VASCULAR LIGATION 00092 T LEVEL II VASCULAR LIGATION 00093 T VASCULAR REPAIR/FISTULA CONSTRUCTION 00094 S RESUSCITATION AND CARDIOVERSION 00095 S CARDIAC REHABILITATION 00096 S NON-INVASIVE VASCULAR STUDIES 00097 S CARDIOVASCULAR STRESS TEST 00098 T INJECTION OF SCLEROSING SOLUTION 00099 S CONTINUOUS CARDIAC MONITORING 00100 S CONTINUOUS ECG 00101 S TILT TABLE EVALUATION 00102 S ELECTRONIC ANALYSIS OF PACEMAKERS/OTHER DEVICES 00109 S BONE MARROW HARVESTING AND BONE MARROW/STEM CELL TRANSPLANT 00110 S TRANSFUSION 00111 S BLOOD PRODUCT EXCHANGE 00112 S EXTRACORPOREAL PHOTOPHERESIS 00113 T EXCISION LYMPHATIC SYSTEM 00114 T THYROID/LYMPHADENECTOMY PROCEDURES 00116 S CHEMOTHERAPY ADMINISTRATION BY OTHER TECHNIQUE EXCEPT INFUSION 00117 S CHEMOTHERAPY ADMINISTRATION BY INFUSION ONLY 00118 S CHEMOTHERAPY ADMINISTRATION BY BOTH INFUSION AND OTHER TECHNIQUE 00120 S INFUSION THERAPY EXCEPT CHEMOTHERAPY 00121 T LEVEL I TUBE CHANGES AND REPOSITIONING 00122 T LEVEL II TUBE CHANGES AND REPOSITIONING 00123 T LEVEL III TUBE CHANGES AND REPOSITIONING 00130 T LEVEL I LAPAROSCOPY 00131 T LEVEL II LAPAROSCOPY 00132 T LEVEL III LAPAROSCOPY 00140 T ESOPHAGEAL DILATION WITHOUT ENDOSCOPY 00141 T UPPER GI PROCEDURES 00142 T SMALL INTESTINE ENDOSCOPY 00143 T LOWER GI ENDOSCOPY 00144 T DIAGNOSTIC ANOSCOPY 00145 T THERAPEUTIC ANOSCOPY 00146 T LEVEL I SIGMOIDOSCOPY 00147 T LEVEL II SIGMOIDOSCOPY 00148 T LEVEL I ANAL/RECTAL PROCEDURE 00149 T LEVEL II ANAL/RECTAL PROCEDURE 00150 T LEVEL III ANAL/RECTAL PROCEDURE 00151 T ENDOSCOPIC RETROGRADE CHOLANGIO-PANCREATOGRAPHY (ERCP) 00152 T PERCUTANEOUS BILIARY ENDOSCOPIC PROCEDURES 00153 T PERITONEAL AND ABDOMINAL PROCEDURES 00154 T HERNIA/HYDROCELE PROCEDURES 00157 S COLORECTAL CANCER SCREENING: BARIUM ENEMA 00158 S COLORECTAL CANCER SCREENING: COLONOSCOPY 00159 S COLORECTAL CANCER SCREENING: FLEXIBLE SIGMOIDOSCOPY 00160 T LEVEL I CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES 00161 T LEVEL II CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES 00162 T LEVEL III CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES 00163 T LEVEL IV CYSTOURETHROSCOPY AND OTHER GENITOURINARY PROCEDURES 00164 T LEVEL I URINARY AND ANAL PROCEDURES 00165 T LEVEL II URINARY AND ANAL PROCEDURES 00166 T LEVEL I URETHRAL PROCEDURES 00167 T LEVEL II URETHRAL PROCEDURES 00168 T LEVEL III URETHRAL PROCEDURES 00169 T LITHOTRIPSY 00170 S DIALYSIS FOR OTHER THAN ESRD PATIENTS 00180 T CIRCUMCISION 00181 T PENILE PROCEDURES 00182 T INSERTION OF PENILE PROSTHESIS 00183 T TESTES/EPIDIDYMIS PROCEDURES 00184 T PROSTATE BIOPSY 00190 T SURGICAL HYSTEROSCOPY 00191 T LEVEL I FEMALE REPRODUCTIVE PROCEDURES 00192 T LEVEL II FEMALE REPRODUCTIVE PROCEDURES 00193 T LEVEL III FEMALE REPRODUCTIVE PROCEDURES 00194 T LEVEL IV FEMALE REPRODUCTIVE PROCEDURES 00195 T LEVEL V FEMALE REPRODUCTIVE PROCEDURES 00196 T DILATATION & CURETTAGE 00197 T INFERTILITY PROCEDURES 00198 T PREGNANCY AND NEONATAL CARE PROCEDURES 00199 T VAGINAL DELIVERY 00200 T THERAPEUTIC ABORTION 00201 T SPONTANEOUS ABORTION 00210 T SPINAL TAP 00211 T LEVEL I NERVOUS SYSTEM INJECTIONS 00212 T LEVEL II NERVOUS SYSTEM INJECTIONS 00213 S EXTENDED EEG STUDIES AND SLEEP STUDIES 00214 S ELECTROENCEPHALOGRAM 00215 S LEVEL I NERVE AND MUSCLE TESTS 00216 S LEVEL II NERVE AND MUSCLE TESTS 00217 S LEVEL III NERVE AND MUSCLE TESTS 00220 T LEVEL I NERVE PROCEDURES 00221 T LEVEL II NERVE PROCEDURES 00222 T IMPLANTATION OF NEUROLOGICAL DEVICE 00223 T LEVEL I REVISION/REMOVAL NEUROLOGICAL DEVICE 00224 T LEVEL II REVISION/REMOVAL NEUROLOGICAL DEVICE 00225 T IMPLANTATION OF NEUROSTIMULATOR ELECTRODES 00230 S LEVEL I EYE TESTS 00231 S LEVEL II EYE TESTS 00232 T LEVEL I ANTERIOR SEGMENT EYE 00233 T LEVEL II ANTERIOR SEGMENT EYE 00234 T LEVEL III ANTERIOR SEGMENT EYE PROCEDURES 00235 T LEVEL I POSTERIOR SEGMENT EYE PROCEDURES 00236 T LEVEL II POSTERIOR SEGMENT EYE PROCEDURES 00237 T LEVEL III POSTERIOR SEGMENT EYE PROCEDURES 00238 T LEVEL I REPAIR AND PLASTIC EYE PROCEDURES 00239 T LEVEL II REPAIR AND PLASTIC EYE PROCEDURES 00240 T LEVEL III REPAIR AND PLASTIC EYE PROCEDURES 00241 T LEVEL IV REPAIR AND PLASTIC EYE PROCEDURES 00242 T LEVEL V REPAIR AND PLASTIC EYE PROCEDURES 00243 T STRABISMUS/MUSCLE PROCEDURES 00244 T CORNEAL TRANSPLANT 00245 T CATARACT PROCEDURES WITHOUT IOL INSERT 00246 T CATARACT PROCEDURES WITH IOL INSERT 00247 T LASER EYE PROCEDURES EXCEPT RETINAL 00248 T LASER RETINAL PROCEDURES 00250 T NASAL CAUTERIZATION/PACKING 00251 T LEVEL I ENT PROCEDURES 00252 T LEVEL II ENT PROCEDURES 00253 T LEVEL III ENT PROCEDURES 00254 T LEVEL IV ENT PROCEDURES 00256 T LEVEL V ENT PROCEDURES 00257 T IMPLANTATION OF COCHLEAR DEVICE 00258 T TONSIL AND ADENOID PROCEDURES 00260 X LEVEL I PLAIN FILM EXCEPT TEETH 00261 X LEVEL II PLAIN FILM EXCEPT TEETH INCLUDING BONE DENSITY MEASUREMENT 00262 X PLAIN FILM OF TEETH 00263 X LEVEL I MISCELLANEOUS RADIOLOGY PROCEDURES 00264 X LEVEL II MISCELLANEOUS RADIOLOGY PROCEDURES 00265 S LEVEL I DIAGNOSTIC ULTRASOUND EXCEPT VASCULAR 00266 S LEVEL II DIAGNOSTIC ULTRASOUND EXCEPT VASCULAR 00267 S VASCULAR ULTRASOUND 00268 X GUIDANCE UNDER ULTRASOUND 00269 S ECHOCARDIOGRAM EXCEPT TRANSESOPHAGEAL 00270 S TRANSESOPHAGEAL ECHOCARDIOGRAM 00271 S MAMMOGRAPHY 00272 X LEVEL I FLUOROSCOPY 00273 X LEVEL II FLUOROSCOPY 00274 S MYELOGRAPHY 00275 S ARTHROGRAPHY 00276 S LEVEL I DIGESTIVE RADIOLOGY 00277 S LEVEL II DIGESTIVE RADIOLOGY 00278 S DIAGNOSTIC UROGRAPHY 00279 S LEVEL I DIAGNOSTIC ANGIOGRAPHY AND VENOGRAPHY EXCEPT EXTREMITY 00280 S LEVEL II DIAGNOSTIC ANGIOGRAPHY AND VENOGRAPHY EXCEPT EXTREMITY 00281 S VENOGRAPHY OF EXTREMITY 00282 S LEVEL I COMPUTERIZED AXIAL TOMOGRAPHY 00283 S LEVEL II COMPUTERIZED AXIAL TOMOGRAPHY 00284 S MAGNETIC RESONANCE IMAGING 00285 S POSITRON EMISSION TOMOGRAPHY (PET) 00286 S MYOCARDIAL SCANS 00290 S STANDARD NON-IMAGING NUCLEAR MEDICINE 00291 S LEVEL I DIAGNOSTIC NUCLEAR MEDICINE EXCLUDING MYOCARDIAL SCANS 00292 S LEVEL II DIAGNOSTIC NUCLEAR MEDICINE EXCLUDING MYOCARDIAL SCANS 00294 S LEVEL I THERAPEUTIC NUCLEAR MEDICINE 00295 S LEVEL II THERAPEUTIC NUCLEAR MEDICINE 00296 S LEVEL I THERAPEUTIC RADIOLOGIC PROCEDURES 00297 S LEVEL II THERAPEUTIC RADIOLOGIC PROCEDURES 00300 S LEVEL I RADIATION THERAPY 00301 S LEVEL II RADIATION THERAPY 00302 S LEVEL III RADIATION THERAPY 00303 X TREATMENT DEVICE CONSTRUCTION 00304 X LEVEL I THERAPEUTIC RADIATION TREATMENT PREPARATION 00305 X LEVEL II THERAPEUTIC RADIATION TREATMENT PREPARATION 00310 X LEVEL III THERAPEUTIC RADIATION TREATMENT PREPARATION 00311 X RADIATION PHYSICS SERVICES 00312 S RADIOELEMENT APPLICATIONS 00313 S BRACHYTHERAPY 00314 S HYPERTHERMIC THERAPIES 00320 S ELECTROCONVULSIVE THERAPY 00321 S BIOFEEDBACK AND OTHER TRAINING 00322 S BRIEF INDIVIDUAL PSYCHOTHERAPY 00323 S EXTENDED INDIVIDUAL PSYCHOTHERAPY 00324 S FAMILY PSYCHOTHERAPY 00325 S GROUP PSYCHOTHERAPY 00330 S DENTAL PROCEDURES 00340 X MINOR ANCILLARY PROCEDURES 00341 X IMMUNOLOGY TESTS 00342 X LEVEL I PATHOLOGY 00343 X LEVEL II PATHOLOGY 00344 X LEVEL III PATHOLOGY 00354 X ADMINISTRATION OF INFLUENZA VACCINE 00355 X LEVEL I IMMUNIZATIONS 00356 X LEVEL II IMMUNIZATIONS 00357 X LEVEL III IMMUNIZATIONS 00358 X LEVEL IV IMMUNIZATIONS 00359 X INJECTIONS 00360 X LEVEL I ALIMENTARY TESTS 00361 X LEVEL II ALIMENTARY TESTS 00362 X FITTING OF VISION AIDS 00363 X OTORHINOLARYNGOLOGIC FUNCTION TESTS 00364 X LEVEL I AUDIOMETRY 00365 X LEVEL II AUDIOMETRY 00366 X ELECTROCARDIOGRAM (ECG) 00367 X LEVEL I PULMONARY TEST 00368 X LEVEL II PULMONARY TESTS 00369 X LEVEL III PULMONARY TESTS 00370 X ALLERGY TESTS 00371 X ALLERGY INJECTIONS 00372 X THERAPEUTIC PHLEBOTOMY 00373 X NEUROPSYCHOLOGICAL TESTING 00374 X MONITORING PSYCHIATRIC DRUGS 00600 V LOW LEVEL CLINIC VISITS 00601 V MID LEVEL CLINIC VISITS 00602 V HIGH LEVEL CLINIC VISITS 00603 V INTERDISCIPLINARY TEAM CONFERENCE 00610 V LOW LEVEL EMERGENCY VISITS 00611 V MID LEVEL EMERGENCY VISITS 00612 V HIGH LEVEL EMERGENCY VISITS 00620 S CRITICAL CARE 00701 G SR 89 CHLORIDE, PER MCI 00702 G SM 153 LEXIDRONAM, 50 MCI 00704 G IN 111 SATUMOMAB PENDETIDE PER DOSE 00705 G TC 99M TETROFOSMIN, PER DOSE 00725 G LEUCOVORIN CALCIUM INJ, 50 MG 00726 G DEXRAZOXANE HCL INJECTION, 250 MG 00727 G ETIDRONATE DISODIUM INJ 300 MG 00728 G FILGRASTIM 300 MCG INJECTION 00730 G PAMIDRONATE DISODIUM , 30 MG 00731 G SARGRAMOSTIM INJECTION 50 MCG 00732 G MESNA INJECTION 200 MG 00733 G NON ESRD EPOETIN ALPHA INJ, 1000 U 00750 G DOLASETRON MESYLATE, 10 MG 00754 G METOCLOPRAMIDE HCL INJECTION UP TO 10 MG 00755 G THIETHYLPERAZINE MALEATE INJ UP TO 10 MG 00761 G UNSPECIFIED ORAL ANTI-EMETIC 00762 G DRONABINOL 2.5MG ORAL 00763 G DOLASETRON MESYLATE ORAL, 100 MG 00764 G GRANISETRON HCL INJECTION 10 MCG 00765 G GRANISETRON HCL 1 MG ORAL 00768 G ONDANSETRON HCL INJECTION 1 MG 00769 G ONDANSETRON HCL 8MG ORAL 00800 G LEUPROLIDE ACETATE, 3.75 MG 00801 G CYCLOPHOSPHAMIDE ORAL 25 MG 00802 G ETOPOSIDE ORAL 50 MG 00803 G MELPHALAN ORAL 2 MG 00807 G ALDESLEUKIN/SINGLE USE VIAL 00809 G BCG LIVE INTRAVESICAL VAC 00810 G GOSERELIN ACETATE IMPLANT 3.6 MG 00811 G CARBOPLATIN INJECTION 50 MG 00812 G CARMUS BISCHL NITRO INJ 100 MG 00813 G CISPLATIN 10 MG INJECTION 00814 G ASPARAGINASE INJECTION 10,000 U 00815 G CYCLOPHOSPHAMIDE 100 MG INJ 00816 G CYCLOPHOSPHAMIDE LYOPHILIZED 100 MG 00817 G CYTARABINE HCL 100 MG INJ 00818 G DACTINOMYCIN 0.5 MG 00819 G DACARBAZINE 10 MG INJ 00820 G DAUNORUBICIN 10 MG 00821 G DAUNORUBICIN CITRATE LIPOSOM 10 MG 00822 G DIETHYLSTILBESTROL INJECTION 250 MG 00823 G DOCETAXEL, 20 MG 00824 G ETOPOSIDE 10 MG INJ 00826 G METHOTREXATE ORAL 2.5 MG 00827 G FLOXURIDINE INJECTION 500 MG 00828 G GEMCITABINE HCL 200 MG 00830 G IRINOTECAN INJECTION 20 MG 00831 G IFOSFOMIDE INJECTION 1 GM 00832 G IDARUBICIN HCL INJECTION 5 MG 00833 G INTERFERON ALFACON-1, 1 MCG 00834 G INTERFERON ALFA-2A INJ RECOMBINANT 3 MILLION U 00836 G INTERFERON ALFA-2B INJ RECOMBINANT, 1 MILLION 00838 G INTERFERON GAMMA 1-B INJ, 3 MILLION U 00839 G MECHLORETHAMINE HCL INJ 10 MG 00840 G MELPHALAN HYDROCHL 50 MG 00841 G METHOTREXATE SODIUM INJ 5 MG 00842 G FLUDARABINE PHOSPHATE INJ 50 MG 00843 G PEGASPARGASE, SINGL DOSE VIAL 00844 G PENTOSTATIN INJECTION, 10 MG 00847 G DOXORUBICIN HCL 10 MG VL CHEMO 00849 G RITUXIMAB, 100 MG 00850 G STREPTOZOCIN INJECTION, 1 GM 00851 G THIOTEPA INJECTION, 15 MG 00852 G TOPOTECAN, 4 MG 00853 G VINBLASTINE SULFATE INJ, 1 MG 00854 G VINCRISTINE SULFATE 1 MG INJ 00855 G VINORELBINE TARTRATE, 10 MG 00856 G PORFIMER SODIUM, 75 MG 00857 G BLEOMYCIN SULFATE INJECTION 15 U 00858 G CLADRIBINE, 1MG 00859 G FLUOROURACIL INJECTION 500 MG 00860 G PLICAMYCIN (MITHRAMYCIN) INJ 2.5 MG 00861 G LEUPROLIDE ACETATE INJECTION 1 MG 00862 G MITOMYCIN 5 MG INJ 00863 G PACLITAXEL INJECTION, 30 MG 00864 G MITOXANTRONE HCL, 5 MG 00865 G INTERFERON ALFA-N3 INJ, HUMAN LEUKOCYTE DERIVED, 250,000 IU 00884 G RHO D IMMUNE GLOBULIN INJ, 1 DOSE PKG 00886 G AZATHIOPRINE ORAL 50MG 00887 G AZATHIOPRINE PARENTERAL 100 MG 00888 G CYCLOSPORINE ORAL 100 MG 00889 G CYCLOSPORIN PARENTERAL 250MG 00890 G LYMPHOCYTE IMMUNE GLOBULIN 250 MG 00891 G TACROLIMUS ORAL PER 1 MG 00900 G ALGLUCERASE INJECTION, PER 10 U 00901 G ALPHA 1 PROTEINASE INHIBITOR, 10 MG 00902 G BOTULINUM TOXIN A, PER UNIT 00903 G CYTOMEGALOVIRUS IMM IV, 50 MG 00905 G IMMUNE GLOBULIN 500 MG 00906 G RSV-IVIG, 50 MG 00907 X GANCICLOVIR SODIUM 500 MG INJECTION 00908 G TETANUS IMMUNE GLOBULIN INJ UP TO 250 U 00909 G INTERFERON BETA-1A, 33 MCG 00910 G INTERFERON BETA-1B , .25 MG 00911 X STREPTOKINASE PER 250,000 IU 00913 G GANCICLOVIR LONG ACT IMPLANT 4.5 MG 00914 X RETEPLASE, 37.6 MG (TWO SINGLE USE VIALS) 00915 X ALTEPLASE RECOMBINANT, 10MG 00916 G IMIGLUCERASE, UNIT 00917 X PHARMACOLOGIC STRESSORS 00918 H BRACHYTHERAPY SEEDS, ANY TYPE, EACH 00925 G FACTOR VIII PER IU 00926 G FACTOR VIII (PORCINE) PER IU 00927 G FACTOR VIII RECOMBINANT PER IU 00928 G FACTOR IX COMPLEX PER IU 00929 G ANTI-INHIBITOR PER IU 00930 G ANTITHROMBIN III INJECTION PER IU 00931 G FACTOR IX NON-RECOMBINANT, PER IU 00932 G FACTOR IX RECOMBINANT, PER IU 00949 S PLASMA, POOLED MULTIPLE DONOR, SOLVENT/DETERGENT TREATED, FROZEN 00950 S BLOOD (WHOLE) FOR TRANSFUSION 00952 S CRYOPRECIPITATE 00953 S FIBRINOGEN UNIT 00954 S LEUKOCYTE POOR BLOOD 00955 S PLASMA, FRESH FROZEN 00956 S PLASMA PROTEIN FRACTION 00957 S PLATELET CONCENTRATE 00958 S PLATELET RICH PLASMA 00959 S RED BLOOD CELLS 00960 S WASHED RED BLOOD CELLS 00961 X INFUSION, ALBUMIN (HUMAN) 5%, 500 ML 00962 X INFUSION, ALBUMIN (HUMAN) 25%, 50 ML 00970 T NEW TECHNOLOGY - LEVEL I ($0 - $50) 00971 S NEW TECHNOLOGY - LEVEL II ($50 - $100) 00972 T NEW TECHNOLOGY - LEVEL III ($100 - $200) 00973 T NEW TECHNOLOGY - LEVEL IV ($200 - $300) 00974 S NEW TECHNOLOGY - LEVEL V ($300 - $500) 00975 T NEW TECHNOLOGY - LEVEL VI ($500 - $750) 00976 S NEW TECHNOLOGY - LEVEL VII ($750 - $1000) 00977 T NEW TECHNOLOGY - LEVEL VIII ($1000 - $1250) 00978 T NEW TECHNOLOGY - LEVEL IX ($1250 - $1500) 00979 T NEW TECHNOLOGY - LEVEL X ($1500 - $1750) 00980 T NEW TECHNOLOGY - LEVEL XI ($1750 - $2000) 00981 S NEW TECHNOLOGY - LEVEL XII ($2000 - $2500) 00982 T NEW TECHNOLOGY - LEVEL XIII ($2500 - $3500) 00983 T NEW TECHNOLOGY - LEVEL XIV ($3500 - $5000) 00984 T NEW TECHNOLOGY - LEVEL XV ($5000 - $6000) 01000 H PERCLOSE CLOSER PROSTAR ARTERIAL VASCULAR CLOSURE 01001 H ACUNAV-DIAGNSTIC ULTRSND CA 01002 H COCHLEAR IMPLANT SYSTEM 01005 H SENSOR POST.CHAMB IOL 01006 H ARRAY POST CHAMB IOL 01007 H AMS 700 PENILE PROSTHESIS 01008 H UROLUME-IMPLT URETHRAL STENT 01009 S PLASMA, CRYOPRECIPITATE-REDUCED, UNIT 01010 S BLOOD, L/R, CMV-NEG 01011 S PLATELETS, L/R, CMV-NEG, UNIT 01012 S PLATELET CONCENTRATE, L/R, IRRADIATED, UNIT 01013 S PLATELET CONCENTRATE, L/R, UNIT 01014 S PLATELETS, APH/PHER, L/R, UNIT 01016 S BLOOD, L/R, FROZ/DEGLYCEROL/WASHED 01017 S PLATELETS, APH/PHER, L/R, CMV-NEG, UNIT 01018 S BLOOD, L/R, IRRADIATED 01019 S PLATELETS, APH/PHER, L/R, IRRADIATED, UNIT 01024 J QUINUPRISTIN 150 MG/DALFOPRISTON 350 MG 01025 H MARINR CS CATHETER 01026 H RF PERFRMR CATH 5F RF MARINR 01027 H MAGIC WALLSTENT STENT-SHORT, X/SHT RAD 14MM 01028 H PRCIS TWST TRNSVG ANCH SYS 01029 H CRE GUIDED BALLOON DIL CATH 01030 H CTHTR:MRSHAL,BLU MAX UTR DMND 01031 H MR COMP/MOD LEVEEN NED ELECT 01033 H SONICATH MDL 37-410 01034 H SURPASS, LONG30 SURPASS-CATH 01035 H ULTRAFLEX TRACHEOBRONCHIAL, ENDOPCOSTHESIS 01036 H R PORT/RESERVOIR IMPL DEV 01037 H VAXCELCHRONIC DIALYSIS CATH 01039 H WALLSTENT: TRACHEOBRONCHIAL 01040 H WALLSTENT: TIPS (SHUNT) 01042 H WALLSTENT: BILIARY 01043 H AHTERECTOMY SYS, CORONARY 01044 H BIOZ.COM: SENSOR 01045 G I-131 MIBG (IOBEN-SULFATE) O.5MCI 01047 H NOGA/NAVI-STAR CATHETER 01048 H NEUROCYBERNETICPROS: GEN 01053 H ENSITE 3000 CATHETER 01057 H MICROMARK TISSUE MARKER 01059 H CARTICEL,AUTO CULT-CHNDR CYTE 01060 H ACS MULTI-LINK TRISTOR STENT 01061 H ACS VIKING GUIDING CATH 01063 H ENDOTAK ENDURANCE EZ, RX LEADS 01067 H MEGALINK BILIARY STENT 01068 H PULSAR DDD PMKR 01069 H DISCOVERY DR, PMAKER 01071 H PULSAR MAX, PULSAR SR PMKR 01072 H GUIDANT BLLN DIL CATH 01073 H MORCELLATOR 01074 H RX/OTW VIATRAC-PERI DIL CATH 01075 H GUIDANT: LEAD 01076 H VENTAK MINI SC DEFIB 01077 H VENTAK VR PRIZM VR, SC DEFIB 01078 H VENTAK: PRIZM, AVIIIDR DEFIB 01079 G CO 57/58, .5 MCI 01084 G DENILEUKIN DIFTITOX, 300 MCG 01086 G TEMOZOLOMIDE, 5 MG 01087 G I 123 PER UCI CAP 01089 G CO 57, 0.5 MCI, CAPSULE 01090 G IN 111 CHLORIDE, PER MCI 01091 G IN 111 OXYQUINOLINE, PER 5 MCI 01092 G IN 111 PENTETATE, PER 1.5 MCI 01094 J TC 99M ALBUMIN AGGR, PER VIAL 01095 G TC 99M DEPREOTIDE, PER VIAL 01096 J TC 99M EXAMETAZIME, PER VIAL 01097 G TC 99M MEBROFENIN, PER VIAL 01098 G TC 99M PENTETATE, PER VIAL 01099 J TC 99M PYROPHOSPHATE, PER VIAL 01100 H MEDTRONIC AVE GT1 GUIDEWIRE 01101 H MEDTRONICAVE ZUMA GUIDECATH 01102 H SYNERGY NEUROSTIM GENRTR 01103 H MICRO JEWEL DEFIBRILLATOR 01104 H RF CONDUCTOR ABLATIVE CATH 01105 H SIGMA 300VDD PACMKER 01106 H SYNERGYEZ PT PROGRMR 01107 H TORQR, SOLIST CATH 01108 H REVEAL CARDIAC RECORDER 01109 H IMPLANTABLE ANCHOR: ETHICON 01110 H STABLE MAPPER, CATH ELECTRD 01111 H ANEURXAORT-UNI-ILICSTNT&CATH 01112 H ANEURX STENT GRAFT/DEL.CATH 01113 H TLNT ENDO SPRNG STNT GRFT SYS 01114 H TALNTSPRGSTNT+GRAF ENDO PROS 01115 H 5038S,5038,5038L PACE LEAD 01116 H CAPSURESP PACING LEAD 01118 H SIGMA300DR LEGIIDR,PACEMKR 01119 H SPRINT6932,6943 DEFIB LEAD 01120 H SPRINT6942,6945 DEFIB LEAD 01121 H GEM DEFIBRILLATOR 01122 G TC 99M ARCITUMOMAB PER VIAL 01123 H GEM II VR DEFIBRILLATOR 01124 H INTERSTIM TEST STIM KIT 01125 H KAPPA 400SR,TTOPAZ II SR PMKR 01126 H KAPPA 700 DR PACEMAKR 01127 H KAPPA 700SR,PMKR SGL CHAMBER 01128 H KAPPA 700D,RUBY IID PMKR 01129 H KAPPA 700VDD,PACMKR 01130 H SIGMA 200D,LGCY IID SC PMKR 01131 H SIGMA 200DR, PMKER 01132 H SIGMA 200SR LEG II:SC PAC 01133 H SIGMA SR, VITA SR, PMAKER 01134 H SIGMA 300D PMKER 01137 H CARDIOSEAL IMPLANT SYST 01143 H ADDVENT MOD 2060BL,VDD 01144 H AFNTY SP 5130,INTEGRITY SR,PMKR 01145 H ANGIO-SEAL 6FR, 8FR 01146 H VETT TUBE 01147 H AV PLUS DX 1368: LEAD 01148 H CONTOUR MD SC DEFIB 01149 H ENTITY DC 5226R-PMKER 01151 H PASSIVEPLUS DX LEAD, 10 MDLS 01152 H LIFESITE ACCESS SYSTEM 01153 H REGENCY SC+ 2402L PMKER 01154 H SPL:SPOI,02,04- DEFIB LEAD 01155 H REPLIFORM 8 SQ CM 01156 H TR 1102TRSR+ 2260L,2264L,5131 01157 H TRILOGY DCT 23/8L PMKR 01158 H TVL LEAD SV01,SV02,SV04 01159 H TVL RV02,RV06,RV07: LEAD 01160 H TVL-ADX 1559: LEAD 01161 H TENDRIL DX, 1388 PACING LEAD 01162 H TEMPODR, TRILOGYDR+DC PMKR 01163 H TENDRIL SDX, 1488T PACING LEAD 01164 H IODINE-125 BRACHYTX SEED 01166 G CYTARABINE LIPOSOMAL, 10 MG 01167 J EPIRUBICIN HCL, 2 MG 01170 H ABBI DISP BIOPSY DEVICE 01171 H AUTOSUTURE SITE MARKER STPLE 01172 H SPACEMAKER DISSECT BALLON 01173 H COR STNTS540,S670,O-WIRE STN 01174 H BARD BRACHYTX NEEDLE 01178 G BUSULFAN IV, 6 MG 01188 G I-131 SODIUM IODIDE, CAPSULE 01200 G TC 99M SODIUM GLUCOHEPTONATE, PER VIAL 01201 G TC 99M SUCCIMER, PER VIAL 01202 G TC 99M SULFUR COLLOID, PER VIAL 01203 G VERTEPORFIN FOR INJECTION 01205 G TC 99M DISOFENIN, PER VIAL 01207 G OCTREOTIDE ACETATE DEPOT 1MG 01302 H SQ01: LEAD 01303 H BILIARY SYSTEM 01304 H SONICATH MDL 37-416,-418 01305 H APLIGRAF 01306 H NEUROCYBERNETICPROS: LEAD 01311 H TRILOGY DR+/DAO PMKR 01312 H MAGIC WALLSTENT STENT-MINI 01313 H MAGIC WALLSTENT -MEDIUM RAD 31MM 01314 H MAGIC WALLSTENT STENT-LONG 01315 H VIGOR DR, MERIDIAN DR PMKR 01316 H MERIDIAN DDD PMKR 01317 H DISCOVERY SR, PMKR 01318 H MERIDIAN SR PMAKR 01319 H WALLSTENT: ENTERAL 01320 H WALLSTENT: ILIAC 01324 H LIGASURE DISPOSABLE ELECTRODE 01325 H PALLIDIUM -103 SEED 01326 H ANGIO-JET RHEOLYTIC THROMB CATH 01328 H ANS RENEW NS TRANSMTR 01333 H PALMAZ CORINTHIAN BILL STENT 01334 H CROWN, MINI CROWN, CROSSLC 01335 H MESH, PROLENE 01336 H CONSTANT FLOW IMP PUMP 01348 G I 131 SODIUM IODIDE, SOLUTION, PER VIAL 01350 H PROSTA/ONCOSEED, RAPID STRAND, I-125 01351 H CAPSURE(FIX)PACING LEAD 01352 H GEM II DEFIB 01353 H ITREL INTERSTM NEUROSTIM+EXT 01354 H KAPPA 400DR,DIAMOND II 820DR 01355 H KAPPA 600DR, VITA DR 01356 H PROFILE MD V-186HV3 SC DEFIB 01357 H ANGSTROM MD V-190HV3 SC DEFIB 01358 H AFFINITY DC 5230R-PACEMAKER 01359 H PULSAR,PULSAR MAX DR,PMKR 01400 G DIPHENHYDRAMINE HCL 50MG 01401 G PROCHLORPERAZINE MALEATE 5MG 01402 G PROMETHAZINE HCL 12.5MG ORAL 01403 G CHLORPROMAZINE HCL 10MG ORAL 01404 G TRIMETHOBENZAMIDE HCL 250MG 01405 G THIETHYLPERAZINE MALEATE10MG 01406 G PERPHENAZINE 4MG ORAL 01407 G HYDROXYZINE PAMOATE 25MG 01409 G FACTOR VIIA RECOMBINANT, PER 1.2 MG 01410 H PROSORBA COLUMN 01411 H HERCULINK,OTW SDS BIL STENT 01600 G TC 99M SESTAMIBI, PER SYRINGE 01601 G TC 99M MEDRONATE, PER DOSE 01602 G TC 99M APCITIDE, PER VIAL 01603 G TL 201, MCI 01604 G IN 111 CAPROMAB PENDETIDE, PER DOSE 01605 G ABCIXIMAB INJECTION, 10 MG 01606 G ANISTREPLASE, 30 U 01607 G EPTIFIBATIDE INJECTION, 5 MG 01608 G ETANERCEPT INJECTION, 25 MG 01609 G RHO(D) IMMUNE GLOBULIN H, SD, 100 IU 01610 G THYROTROPIN INJECTION, 0.9 MG 01611 G HYLAN G-F 20 INJECTION, 16 MG 01612 G DACLIZUMAB, PARENTERAL, 25 MG 01613 G TRASTUZUMAB, 10 MG 01614 G VALRUBICIN, 200 MG 01615 G BASILIXIMAB, 20 MG 01616 G HISTRELIN ACETATE, 0.5 MG 01617 G LEPIRDIN, 50 MG 01618 G VON WILLEBRAND FACTOR, PER IU 01619 G GA 67, PER MCI 01620 G TC 99M BICISATE, PER VIAL 01621 G XE 133, PER MCI 01622 G TC 99M MERTIATIDE, PER VIAL 01623 G TC 99M GLUCEPTATE 01624 G P32 SODIUM, PER MCI 01625 G IN 111 PENTETREOTIDE, PER MCI 01626 G TC 99M OXIDRONATE, PER VIAL 01627 G TC-99 LABELED RED BLOOD CELL, PER TEST 01628 G P32 PHOSPHATE CHROMIC, PER MCI 07000 G AMIFOSTINE, 500 MG 07001 G AMPHOTERICIN B LIPID COMPLEX, 50 MG 07002 G CLONIDINE, HCL, 1MG 07003 G EPOPROSTENOL INJECTION 0.5 MG 07004 G IMMUNE GLOBULIN 5 GMS 07005 G GONADORELIN HYDROCH, 100 MCG 07007 X MILRINONE LACTATE, PER 5 ML, INJ 07010 G MORPHINE SULFATE (PRESERVATIVE FREE) 10 MG 07011 G OPRELVEKIN INJECTION, 5 MG 07012 G PENTAMIDINE ISETHIONATE, 300MG 07014 G FENTANYL CITRATE INJ UP 2 ML 07015 G BUSULFAN, ORAL, 2 MG 07019 G APROTININ, 10,000 KIU 07021 G BACLOFEN INTRATHECAL TRIAL, 50 MCG 07022 G ELLIOT'S B SOLUTION, PER ML 07023 G TREATMENT FOR BLADDER CALCULI, PER 500 ML 07024 G CORTICORELIN OVINE TRIFLUTATE, PER 0.1 MG 07025 G DIGOXIN IMMUNE FAB (OVINE), 40 MG VIAL 07026 G ETHANOLAMINE OLEATE, 100 MG 07027 G FOMEPIZOLE, 1.5 MG 07028 G FOSPHENYTOIN, 50 MG 07029 G GLATIRAMER ACETATE, 20 MG 07030 G HEMIN, 1 MG 07031 G OCTREOTIDE ACETATE INJECTION 1MG 07032 G SERMORELIN ACETATE, 0.5 MG 07033 G SOMATREM, 5 MG 07034 G SOMATROPIN, 1 MG (ANY DERIVATION) 07035 G TENIPOSIDE, 50 MG 07036 X UROKINASE, INJ, IV, 250,000 I.U. 07037 G UROFOLLITROPIN, 75 I.U. 07038 G MUROMONAB-CD3, 5 MG 07039 G PEGADEMASE BOVINE INJ 25 I.U 07040 G PENTASTARCH 10% INJ, 100 ML 07041 G TIROFIBAN HYDROCHLORIDE 12.5 MG 07042 G CAPECITABINE, ORAL, 150 MG 07043 G INFLIXIMAB INJECTION 10 MG 07045 G TRIMETREXATE GLUCORONATE 25 MG 07046 G DOXORUBICIN HCL LIPOSOME INJ 10 MG 07315 G SODIUM HYALURONATE, 20 MG
